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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616499
Report Date: 03/11/2020
Date Signed: 03/11/2020 02:09:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:FOLSOM LAKE MONTESSORI ACADEMYFACILITY NUMBER:
343616499
ADMINISTRATOR:KUDUPUDI, UMARAJESWARIFACILITY TYPE:
830
ADDRESS:196 BLUE RAVINE RD. STE 150TELEPHONE:
(916) 351-9448
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:12CENSUS: 9DATE:
03/11/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vasubabu KudupudiTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kelly Ferrara and Licensing Program Manager (LPM) Bettina Engelman conducted a Plan of Correction inspection at the facility and met with Owner Vasubabu Kudupudi. On March 11th, 2020 at 1:15 PM, LPA and LPM observed nine children in care with three staff.

On February 28th, 2020, LPA issued the following citation: 101221(a) Children's Records are separate and complete.

During today's inspection, LPA and LPM observed that the required documentation was present in each child's file.

LPA and LPM were able to clear the citation today and provided a letter as proof.

There were no deficiencies cited based on today's inspection. LPA provided a Notice of Site visit that must remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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